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Abstract

Introduction: Thyroid storm, also known as thyrotoxic crisis, is an uncommon but potentially life threatening medical emergency if not immediately recognized and treated aggressively. Its signs and symptoms may mimic that of other etiologies including infection and ingestion. It is imperative that pediatric health care providers are able to recognize potential warning signs and initiate appropriate evaluation and management. Methods: This scenario teaches learners to recognize and manage thyroid storm in the emergency setting. It is simulation-based, designed for manikin-based simulation equipment, with an integrated team communication focus. Learners will participate in a simulation scenario and be asked to identify the signs and symptoms of thyroid storm, appropriate evaluation within the emergency department and emergency management. At the end of training, the learners should be able to recognize the seriousness of the situation and manage a full resuscitation team. The primary complications for the team to recognize and manage are altered mental status and vital sign instability. Results: The simulation curriculum presented here was implemented at our institution using pediatric emergency medicine fellows as the targeted learners. Because of the high level of training of the learners, we elected to use the optional stage. The fellows provided feedback regarding the session afterwards. Their comments reflected appreciation for a rare presentation that many had not seen clinically before but that shares features with many other potential diagnoses such as infection or toxidrome. They felt it served as a good educational experience and will remind them to keep an open differential diagnosis and seek out key features from the history or exam that may support and endocrinologic etiology for fever, tachycardia and altered mental status. They also reported that altering the simulation mannequin to have a goiter was helpful. Discussion: Thyroid storm, also known as is an uncommon but potentially life threatening medical emergency if not immediately recognized and treated aggressively. This resource teaches learners to recognize and manage thyroid storm in the emergency setting.